Shoulder, Clavicle, Brachial Disorders COPY Flashcards
What muscles make up the rotator cuff? 4
What bones are involved in the rotator cuff? 5
What are the bones of the shoulder? 5
Joints? 4
- Scapula 1. SC joint
- Humerus 2. AC joint
- Clavicle 3. Glenohumeral Joint
- Sternum 4. Scapular thoracic
- Ribs
What are the muscles of the shoulders?
10
Muscles of the Shoulder
Rotator cuff,
- Supraspinatus,
- Infraspinatus,
- Subscapulars,
- Teres Minor
- Pec Major
- Biceps, long head and short head
- Deltoid
- Trapezius
- Serratus anterior
- Rhomboid
Name 6 shoulder conditions in the lecture?
- Traumatic
- Over use
- Instability
- Fractures
- Age related processes
- Nerve injuries
What is an AC separation typically a result of?
2
Typically as a result of
- falling directly on the tip of the shoulder or
- hockey player getting checked into the boards
AC Separation
- Disruption of which ligaments? 2
- Describe Grades 1-3 separations
- Disruption of the
- Coracoclavicular ligaments and
- Acromioclavicular ligament
AC Separation Clinical Findings
6
- Tenderness at the AC joint
- Possible deformity at the AC joint
- Pain with adduction of the shoulder
- +Cross arm test
- +Paxinos test with anterior and posterior instability
- Pain with doing a dip
Whats paxinos test?
Anterior and Posterior Instability
AC Separation Treatment
- Treated with? 2
- What do we do if pain is persisting depsite conservation management?
1.
- Rest, Ice, NSAIDs
- Sling for comfort for a week or two
2. Weaver-Dunn procedure if pain is persisting despite conservative management. - Reconstruction of CC ligament
Rarely treated with surgery
Return to play and activity is determined on patients comfort level
Clavicle Fracture
How is the mechanism of injury different from an AC joint injury?
Similar mechanism of injury as an AC joint separation only the energy passes through the bone causing a fracture
Rarely treated with surgery although becoming more common to fix
Clavicle Fracture Clinical Findings
4
- Tenderness to palpation over the fracture site of the clavicle.
- Pain with adduction of the shoulder
- Patient will be sitting with shoulders rolled forward
- Deformity at fracture site possible tenting of the skin
Clavicle Fracture Treatment
4
- Rest, Ice, NSAIDs,
- Sling for comfort, possible figure 8
- Return to activity is roughly 8 weeks
- Surgery if significant displacment
Rotator Cuff Tendonitis
- What kind of injury?
- In who? 2
- Often the result of?
- Accompanied in what? 3
- Overuse injury
- typically occurring in throwers in athetes but more common in adults in 4th 5th decades of life
- Often the result of inability to train appropriately during the off season for athletes, weekend warriors
4.
- Inflammation of cuff tendon,
- degenerative fraying,
- bursitis
Rotator Cuff Tendonitis Clinical Presentation
5
- Development of pain after an aggravating activity such as painting the house
- Pain can be insidious without specific injury
- Localized to the anterior lateral aspect of the shoulder
- Pain is worse with reaching overhead or behind the body
- Pain at night difficult to sleep
Rotator Cuff Tendonitis Clinical Exam
6
- Tenderness to palpation over the greater tuberosity or bicepital groove
- Painful arc of motion and elevation
- Full range of motion
- Pain with resisted supraspinatus testing
- Hawkins, + Neers Impingement sign
- No need for MRI unless refractory to treatment
No weakness on exam
Rotator Cuff Tendonitis Clinical Exam: Hawkins Impingement Sign
Rotator Cuff Tendonitis Treatment
4
- Treated aggressively with rest in throwers, “6 weeks of rest”
- Graduated throwing program
- Physical Therapy for Rotator cuff strengthening
- Subacromial Steroid Injection
What muscle is this?
Supraspinatus
What is this strengthening?
Infra/Teres Strengthening
What is this strengthening?
Subscapularis Strengthening
- Rotator Cuff tear is most commonly what kind of process?
- With tears occuring as a result of what?
- What are the most commonly torn rotator cuff tendons? 2
- What is more commonly torn as a result of trauma?
- Rotator cuff tear very uncommon prior to the age of what?
- Risk factors for cuff tear? 3
- Rotator cuff tear is most commonly a degenerative processes with
- tears occurring as a result of breakdown of the tendon and eventual wearing out
- Supraspinatus and Infraspinatus most commonly torn rotator cuff tendon
- Subscapularis more commonly torn as a result of trauma
- Rotator cuff tear very uncommon prior to the age of 30
- Risk factors for cuff tear:
- Age,
- smoking,
- fall
Rotator Cuff Tear Clinical Presentation
- Presents similar to what?
- Presents how? 4
- Pain radiates to where?
- Onset?
- May tell you they felt what at the time of injury?
- Rotator cuff tear presentation is similar to rotator cuff tendonitis
2.
- Pain with reaching overhead,
- night pain, cannot get comfortable lying on shoulder,
- weakness,
- pain over the anterior lateral aspect of the shoulder.
3. Pain radiates to the deltoid insertion
4. Pain can be insidious or as a result of trauma such as a fall or lifting something
5. May have felt a pop at the time of the injury
Rotator Cuff Tear Clinical Exam
- Similar exam to tendonitis with exception of what?
- What kind of issues with range of motion?
- Weakness in External Rotation = __________ tear
- Weakness with Empty Can = ___________ tear
- Weakness with Internal Rotation = _________ tear
- Xray findings?
- weakness of affected rotator cuff
- Full passive range of motion but limited active ROM
- Infraspinatus
- Supraspinatus
- Subscapularis
- X-ray will have subtle findings but most of the time negative
Rotator Cuff Tear Clinical Exam
Special Tests?
4
- Bear Hugger test = Subscapularis
- Lift off test = Subsapularis
- Belly Compression test = Subscapularis
- Hawkins, + Neers